Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study
Recommended Citation
Karamchandani K, Nasa P, Jarzebowski M, Brewster DJ, De Jong A, Bauer PR, Berkow L, Brown CA, 3rd, Cabrini L, Casey J, Cook T, Divatia JV, Duggan LV, Ellard L, Ergan B, Jonsson Fagerlund M, Gatward J, Greif R, Higgs A, Jaber S, Janz D, Joffe AM, Jung B, Kovacs G, Kwizera A, Laffey JG, Lascarrou JB, Law JA, Marshall S, McGrath BA, Mosier JM, Perin D, Roca O, Rollé A, Russotto V, Sakles JC, Shrestha GS, Smischney NJ, Sorbello M, Tung A, Jabaley CS, and Myatra SN. Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study. Intensive Care Med 2024.
Document Type
Article
Publication Date
10-1-2024
Publication Title
Intensive care medicine
Abstract
PURPOSE: Our study aimed to provide consensus and expert clinical practice statements related to airway management in critically ill adults with a physiologically difficult airway (PDA).
METHODS: An international Steering Committee involving seven intensivists and one Delphi methodology expert was convened by the Society of Critical Care Anaesthesiologists (SOCCA) Physiologically Difficult Airway Task Force. The committee selected an international panel of 35 expert clinician-researchers with expertise in airway management in critically ill adults. A Delphi process based on an iterative approach was used to obtain the final consensus statements.
RESULTS: The Delphi process included seven survey rounds. A stable consensus was achieved for 53 (87%) out of 61 statements. The experts agreed that in addition to pathophysiological conditions, physiological alterations associated with pregnancy and obesity also constitute a physiologically difficult airway. They suggested having an intubation team consisting of at least three healthcare providers including two airway operators, implementing an appropriately designed checklist, and optimizing hemodynamics prior to tracheal intubation. Similarly, the experts agreed on the head elevated laryngoscopic position, routine use of videolaryngoscopy during the first attempt, preoxygenation with non-invasive ventilation, careful mask ventilation during the apneic phase, and attention to cardiorespiratory status for post-intubation care.
CONCLUSION: Using a Delphi method, agreement among a panel of international experts was reached for 53 statements providing guidance to clinicians worldwide on safe tracheal intubation practices in patients with a physiologically difficult airway to help improve patient outcomes. Well-designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.
Medical Subject Headings
Humans; Delphi Technique; Intubation, Intratracheal; Critical Illness; Airway Management; Consensus; Adult; Critical Care; Laryngoscopy
PubMed ID
39162823
ePublication
ePub ahead of print
Volume
50
Issue
10
First Page
1563
Last Page
1579
